Hs. Kim et al., Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis, J AM COL C, 37(4), 2001, pp. 1026-1030
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES We sought to determine the relationship between geographical mis
s (GM) and edge restenosis (ERS) following intracoronary radiation therapy.
BACKGROUND Edge restenosis may be a limitation of intracoronary irradiation
to prevent in-stent restenosis (ISR). Inadequate radiation source coverage
of the injured segment (GM) has been proposed as a cause of ERS. We studie
d the relationship between GM and ERS following Ir-192 treatment of ISR.
METHODS There were 100 patients with native vessel ISR in WRIST (Washington
Radiation for In-Stent Restenosis Trial), in which patients with ISR were
first treated with conventional techniques and then randomized to gamma irr
adiation (Ir-192) Or placebo. Geographical miss was defined as segments pro
ximal or distal to the treated lesion that were subjected to injury during
primary intervention but were not covered by the radiation source.
RESULTS Geographical miss was documented in 56 of 164 edges (34%). Edge res
tenosis was noted at eight of 80 radiated edges and in four of 84 placebo e
dges. In the irradiated group, ERS was observed in 21% of edges with GM and
in 4% of edges without GM (p = 0.035). In contrast, in the placebo group,
ERS was observed in only 7% of edges with GM and in 4% of edges without GM
(p = NS). The late edge lumen loss was higher in the irradiated group with
GM as compared to placebo with GM (0.74 +/- 0.57 vs. 0.41 +/- 050 nun, p =
0.016).
CONCLUSIONS Edge restenosis following gamma irradiation treatment of ISR is
related to GM: a mismatch between the segment of artery injured during the
primary catheter-based intervention and the length of the radiation source
. (J Am Coll Cardiol 2001;37:1026-30) (C) 2001 by the American College of C
ardiology.